The occurrence of and factors associated with mental ill-health amongst humanitarian aid workers: A systematic review and meta-analysis.

Abstract

Humanitarian crises and disasters affect millions of people worldwide. Humanitarian aid workers are civilians or professionals who respond to disasters and provide humanitarian assistance. In doing so, they face several stressors and traumatic exposures. Humanitarian aid workers also face unique challenges associated with working in unfamiliar settings. To determine the occurrence of and factors associated with mental ill-health among humanitarian aid workers. CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched from 2005-2020. Grey literature was searched on Google Scholar. PRISMA guidelines were followed and after double screening, studies reporting occurrence of mental ill-health were included. Individual narratives and case studies were excluded, as were studies that reported outcomes in non-humanitarian aid workers. Data on occurrence of mental ill-health and associated factors were independently extracted and combined in a narrative summary. A random effects logistic regression model was used for the meta-analysis. Nine studies were included with a total of 3619 participants, reporting on five types of mental ill-health (% occurrence) including psychological distress (6.5%-52.8%); burnout (8.5%-32%); anxiety (3.8%-38.5%); depression (10.4%-39.0%) and post-traumatic stress disorder (0% to 25%). Hazardous drinking of alcohol ranged from 16.2%-50.0%. Meta-analysis reporting OR (95% CI) among humanitarian aid workers, for psychological distress was 0.45 (0.12-1.64); burnout 0.34 (0.27-0.44); anxiety 0.22 (0.10-0.51); depression 0.32 (0.18-0.57) and PTSD 0.11 (0.03-0.39). Associated factors included young age, being female and pre-existing mental ill-health. Mental ill-health is common among humanitarian aid workers, has a negative impact on personal well-being, and on a larger scale reduces the efficacy of humanitarian organisations with delivery of aid and retention of staff. It is imperative that mental ill-health is screened for, detected and treated in humanitarian aid workers, before, during and after their placements. It is essential to implement psychologically protective measures for individuals working in stressful and traumatic crises.